Good Quality. Ayo Wahlberg
has been shaped by one of the defining governmental objectives found within China’s reproductive complex today, namely the improvement of population quality (renkou suzhi). Further to the treatment of infertility, albeit in far fewer cases, donor sperm is also made available to couples where the male is considered to suffer from a genetic disease that is deemed “not suitable for reproduction” because of a risk that the disease will be transmitted to future offspring, thereby negatively affecting the quality of the newborn population. In chapter 2, we learn how AID both purports to contribute to the improvement of national population quality while at the same time introducing a potential threat to this quality in the form of possible unwitting consanguineous marriage of donor siblings. As we will learn, sperm banking in China is inextricably bound to national family planning objectives to improve the quality of newborns.
The looming images of smog-choked cities, cancer villages, and contaminated food have become iconic of a modernizing China, the tragic, perhaps unavoidable, side effects of a voracious economy. In contemporary China, urban living has become toxic living in many ways. In the third chapter, I examine how the sperm bank—jingzi ku—in China has emerged quite literally as a sanctuary of vitality amid concerns around food safety, air and water pollution, rising infertility, and declining population quality. As a twist on Margaret Lock’s concept of “local biologies,” I suggest exposed biologies have become a matter of concern in China in ways that have created a place for hi-tech sperm banks within China’s restrictive reproductive complex. Exposed biologies are a side effect of modernization processes, as industrially manufactured chemicals are increasingly held culpable for a range of pathologies, from cancers to metabolic diseases, disorders of sex development and infertility. Amid concerns that pollution and modern lifestyles are deteriorating sperm quality in China, the sperm bank stands out as a repository of screened, purified, and quality-controlled vitality and consequently sperm banking can be seen as a form of reproductive insurance, not only for individuals but also for the nation.
In the fourth chapter, I turn my attention toward the mobilization of sperm donors on university campuses. As I have already noted, a limit of five women’s pregnancies per donor in China has spawned “high throughput” sperm banking, which requires getting great numbers of potential donors to show up at the sperm bank for screening. Sperm banks will usually only accept between 10 and 30 percent of those who come in for screening in a given year. For this reason, sperm banks in China are dependent on the efforts of their young recruiters (often former donors themselves) to bring potential donors into the bank. Chapter 4 shows how novel strategies of recruitment have been devised and adjusted to address the chronic shortage of donors in China. Such strategies involve recruiters who seek out male university students through university web message boards and social networking platforms as well as through direct dialogue, especially in men’s dormitories on university campuses. In particular I show how recruitment strategies are designed to appeal to the national and personal pride of university students while also highlighting the financial compensation and free health checks that donors are entitled to. The chapter also shows how daily life in a Chinese sperm bank stands in stark contrast to that in a European or American sperm bank. It is not uncommon for larger sperm banks to receive and assess the samples of up to 100 university students in a single afternoon session, which in turn has great bearing on the donation process for donors.
Donor screening in sperm banks has become increasingly medicalized through the last few decades. Potential donors must submit to physical examinations and blood tests as well as provide detailed medical histories in order to minimize the risk of transmitting infectious or hereditary diseases. In line with international guidelines, sperm samples must be assessed, and those considered suitable for banking quarantined for six months, at which point the donor must be retested for HIV before his “straws” are made available to prospective recipient couples. In chapter 5, I suggest that practices which take place within the sperm bank’s facilities and laboratories can helpfully be analyzed as technologies of assurance (que bao). To “assure” means to render safe or secure, but it also means to ensure. For a sperm bank to be licensed in China it must adhere to family planning laws as well as medical technology regulations, which require it to ensure the safety and quality of its sperm.. Sperm is a vital yet potentially dangerous substance. To improve its quality, sperm banks advise potential donors on how best to prepare themselves prior to donating. To mitigate the dangers sperm poses, sperm banks screen potential donors as a way to prevent transmission of genetic and infectious disease from donor to recipient. They comply with auditable good laboratory and manufacturing practices in order to prevent transmission of bacterial infections between qualified donor samples as well as from qualified donor to recipient. Essential to such practices of assurance are numbers: sperm cells per milliliter, motility grades, percentage of normal morphology, milligrams of fructose per milliliter, and chromosome counts. Such numbers are what make sperm quality auditable and thereby amenable to assurance.
Once quality controlled, donor sperm is “released” to the thousands of couples who are involuntarily childless. In the final chapter, I examine how donor sperm is made available to these couples. For those infertile couples who “borrow” sperm in China, secrecy is vital because male infertility is stigmatized. Indeed, sperm donation operates through a double-blind system where recipients consult with doctors who make their requests to sperm banks, which anonymize donors. When making a decision about which donor to use, doctors and infertile couples cannot know the identity of the donor. Through fertility clinics, AID emerges as an opportunity to achieve a visible pregnancy, a pregnancy that couples are in pursuit of and expected to achieve by family and friends. The chapter examines how in one-child policy China, recipient couples and donors mobilize strategies of “hearth” management and trouble-avoidance even as third-party conception has become acceptable for increasing numbers of involuntarily childless couples who are living with male infertility.
Good Quality is a book about the routinization of sperm banking in China. It is at the same time an exploration of how vitality, which is to say both life (shengming) and living (shenghuo), is assessed and valued in China today. In a country currently beset by enormous transformations, it is little wonder that questions of what good life is abound (see Kleinman et al., 2011; Zhang, Kleinman, & Tu, 2011). In the pages that follow, we will see how an assemblage ethnography of sperm banking in China can provide insight into the ways in which good life emerges out of a heavy accumulation of patterned knowledges and practices around the problem of male infertility, which are calibrated to constantly assess and intervene into that very vitality.
1 The Birth of Assisted Reproductive Technology in China
It’s about 1978, and the first IVF baby was born in the United Kingdom, but during that time, you know, China had had ten years of Cultural Revolution, so we didn’t hear any news from foreign countries and we couldn’t read any materials from foreign countries. So during that time, we didn’t know this great news until 1979, when my father was able to read some newspapers and magazines from foreign countries. That way he learned that a test-tube baby was born in the U.K. in 1978. So he thought that in China, because of the Qing dynasty Chinese people have suffered a lot not only from the war, but also from drugs, because some of them became addicted to drugs. He said that if you want to change the whole country, you must have a healthy body, so it is also important to have a healthy baby for every Chinese family. At that time, my team was doing prenatal diagnosis for genetic diseases and we found many couples with such diseases, but they could only choose to do an abortion; this was the only option for them. My father thought that maybe if we can find a good way to have a sperm and oocyte cultured in vitro, then we can identify not-good genes and choose the good ones. So his first thought for doing IVF technology was not for infertile couples, but for couples with genetic diseases. But this was a long way off and we also found that it was not easy to do this work. After all our research we decided, then, to also do the treatment for infertile couples. (Lu Guangxiu)
There is an almost precise coincidence of timing in the births of Louise Brown in July 1978 and China’s restrictive family planning policy a few months after in 1979. These two landmark events stand at odds with each other in many ways. For Robert Edwards and Patrick Steptoe, the two doctors who helped Lesley and John Brown give birth to Louise using the technique of in vitro fertilization (IVF), infertility was the problem that needed to be overcome.